| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
1,972 |
1,057 |
$301K |
| D1351 |
Sealant - per tooth |
4,732 |
1,635 |
$251K |
| D1120 |
Prophylaxis - child |
3,961 |
3,945 |
$160K |
| D0120 |
Periodic oral evaluation - established patient |
5,163 |
5,142 |
$142K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,121 |
669 |
$102K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,955 |
3,938 |
$101K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,246 |
790 |
$78K |
| D0274 |
Bitewings - four radiographic images |
2,997 |
2,978 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,430 |
1,414 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
532 |
379 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
639 |
440 |
$31K |
| D1110 |
Prophylaxis - adult |
674 |
672 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
4,413 |
4,346 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,498 |
3,971 |
$22K |
| D4910 |
|
260 |
259 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
708 |
684 |
$13K |
| D4342 |
|
122 |
94 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
63 |
46 |
$6K |
| D0272 |
Bitewings - two radiographic images |
581 |
576 |
$6K |
| D2332 |
|
19 |
15 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
40 |
40 |
$693.41 |
| D1999 |
|
440 |
435 |
$0.00 |